2014-07-02T11:15:54-07:00 2013-12-31 990 2013-01-01 390808509 THE MONROE CLINIC INC MONR 6083242775 515 22ND AVENUE MONROE WI 53566 James Nemeth CFO 6083242775 2014-07-02 2013 2015-11-30 17:44:51Z X James Nemeth 515 22nd Ave Monroe WI 53566 170848618 0 X WWW.MONROECLINIC.ORG X 1963 WI THE MONROE CLINIC, INC. PROVIDES HEALTHCARE SERVICES TO THE COMMUNITIES IN AND SURROUNDING GREEN COUNTY, WI AND STEPHENSON COUNTY, IL THAT NEED MEDICAL SERVICES REGARDLESS OF ANY INDIVIDUAL'S ABILITY TO PAY. 15 9 1374 145 1225471 0 535335 173446 162838333 168009534 266741 2656092 -2475044 0 161165365 170839072 0 0 0 0 95767538 101080610 0 0 0 61767107 64111766 157534645 165192376 3630720 5646696 244550154 254726229 107867139 105814903 136683015 148911326 X WORKING TOGETHER TO ACHIEVE THE HIGHEST STANDARDS IN HEALTHCARE, WE CREATE HEALTHY COMMUNITIES THROUGH GOD'S HEALING SPIRIT. VISION: EXCEPTIONAL HEALTHCARE; EXCEPTIONAL EXPERIENCE. 0 0 135395550 0 166784063 MONROE CLINIC IS A NOT-FOR-PROFIT HEALTH SYSTEM FEATURING A MULTI-SPECIALTY CLINIC AND HOSPITAL DEDICATED TO BRINGING THE BEST CARE TO THE COMMUNITIES WE SERVE. WORKING TOGETHER TO ACHIEVE THE HIGHEST STANDARDS OF HEALTH CARE, WE CREATE HEALTHY COMMUNITIES THROUGH GOD'S HEALING SPIRIT. SPONSORED BY THE CONGREGATION OF SISTERS OF ST. AGNES (CSA), MONROE CLINIC OFFERS COMPREHENSIVE HEALTH CARE WITH 120 PROVIDERS, A 24-HOUR EMERGENCY ROOM, HOME CARE AND HOSPICE SERVICES, AS WELL AS MULTIPLE CLINIC LOCATIONS IN SOUTHERN WISCONSIN AND NORTHERN ILLINOIS. IN ALL THAT WE DO, WE ARE DEDICATED TO HELPING OUR PATIENTS GET BETTER FASTER AND STAY HEALTHIER LONGER. AS A STATE-OF-THE-ART HEALTH SYSTEM, WE OFFER ADVANCED MEDICAL EQUIPMENT AND TECHNOLOGY COMBINED WITH CARE AND SENSITIVITY. PHYSICIANS AND STAFF ARE COMMITTED TO PROVIDING PERSONALIZED HEALTH CARE, EDUCATION, AND PEACE OF MIND. OUR PATIENTS BENEFIT FROM EXCEPTIONAL PREVENTIVE AND REAHABILITATION SERVICES AND MORE THAN 25 MEDICAL SPECIALTIES. WITH GOD'S BLESSING, MONROE CLINIC IS ABLE TO MEET THE NEEDS OF THOSE WE ARE PRIVILEGED TO SERVE. 0 0 0 135395550 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 1 65 0 1 1374 1 1 1 0 0 0 0 0 X 15 9 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 IL WI X JAMES NEMETH 6083242775 515 22ND AVENUE MONROE WI 53566 WILLIAM OEMICHEN CHAIRPERSON 3 0 X X 0 0 0 MICHAEL SANDERS PRESIDENT/CEO 50 2 X X X 581336 0 262230 MARK THOMPSON CHIEF MEDICAL OFFICER 50 0 X X 376721 0 144873 SISTER MARY NOEL BROWN DIRECTOR 3 2 X 0 0 0 CHARLES DEARTH DIRECTOR 3 0 X 0 0 0 DAVID DEININGER DIRECTOR 3 0 X 0 0 0 JOHN FREY PHYSICIAN/SECRETARY 50 0 X X 238869 0 46500 MIKE GREENFIELD TREASURER 3 0 X X 0 0 0 PATRICIA JAMES DIRECTOR 3 0 X 0 0 0 RACHEL LONG PHYSICIAN/DIRECTOR 50 0 X 200355 0 41615 CHRISTINE WELLINGTON VICE CHAIRPERSON 3 0 X X 0 0 0 JULIE WILKE VP CLINICAL OPERATIONS 50 0 X 303965 0 117362 PAULA RAIBLEY-ELMER VP/CHIEF NURSING OFFICER 50 0 X 226293 0 83290 JANE WELDON FORMER VP/CLINICAL OPERATIONS 0 0 X 240427 0 11041 LUCINDA WERKHEISER VP/SERVICE EXCELLENCE 50 0 X 166932 0 63463 LANCE SATHOFF PHYSICIAN/ORTHOPEDIC SURGEON 50 0 X 1018146 0 68011 NICHOLAS MAXWELL PHYSICIAN/GENERAL SURGEON 50 0 X 855740 0 56475 ANDREW RIKKERS PHYSICIAN/GENERAL SURGEON 50 0 X 846601 0 63469 DAVID BUCHANAN PHYSICIAN/INTERVENTIONAL CARDIOLOGIST 50 0 X 662338 0 47334 JONATHAN SWINDLE PHYSICIAN/ORTHOPEDIC SURGEON 50 0 X 599783 0 56453 JAMES BERBERET DIRECTOR 3 0 X 0 0 0 DARREN PIPP PHYSICIAN/DIRECTOR 50 0 X 325680 0 43751 CHRISTOPHER SMITH PHYSICIAN/CHIEF OF STAFF 50 0 X 239391 0 40713 SISTER SUSAN STUCKI DIRECTOR 3 0 X 0 0 0 JAMES NEMETH CHIEF FINANCIAL OFFICER 50 0 X 165517 0 66453 7048094 0 1213033 130 1 1 0 AMERISOURCE BERGEN DRUG CORP 27550 NETWORK PLACE CHICAGO IL 60671 PHARMACEUTICALS 9167772 STATE OF WISCONSIN DEPT OF HEALTH SERVICES 1 W WILSON ST MADISON WI 53701 HOSPITAL ASSESSMENT 3588662 OWENS & MINOR 12199 COLLECTION CENTER DR CHICAGOE IL 60693 SURGICAL SUPPLIES 2547251 INTUITIVE SURGICAL PO BOX 39000 SAN FRANCISCO CA 94139 SURGICAL SUPPLIES 1506637 EPIC SYSTEMS CORP 5301 TOKAY BLVD MADISON WI 53711 EHR MANAGEMENT 1521352 38 0 0 0 4372 8574 160500 0 173446 NET PATIENT REVENUE 900099 160463722 160463722 0 0 OTHER OPERATING REVENUE 561499 6320341 6320341 0 0 NON-PATIENT SERVICES 621990 1216848 0 1216848 0 LAUNDRY SERVICES 812320 8623 0 8623 0 0 0 0 0 168009534 1093544 0 0 1093544 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1572094 0 0 9546 1572094 -9546 1562548 0 0 1562548 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 170839072 166784063 1225471 2656092 0 0 0 0 0 0 0 0 4544543 3999198 545345 0 0 0 0 0 75441217 65599354 9841863 0 3366877 2951766 415111 0 12815320 10823481 1991839 0 4912653 4217188 695465 0 0 0 0 0 131476 0 131476 0 54777 0 54777 0 0 0 0 0 0 0 0 0 0 0 8309155 5610758 2698397 0 0 0 0 0 24241304 23810541 430763 0 0 0 0 0 0 0 0 0 2471222 1531465 939757 0 0 0 0 0 0 0 0 0 1141132 926880 214252 0 3686152 3686152 0 0 0 0 0 0 11790326 6646314 5144012 0 0 0 0 0 REPAIRS AND MAINTENANCE 4570676 2034325 2536351 0 DUES AND SUBSCRIPTIONS 1233146 860486 372660 0 MISCELLANEOUS 6482400 2697642 3784758 0 165192376 135395550 29796826 0 113365 136902 37262394 24240330 0 0 21885579 24360809 0 0 0 0 0 0 2808434 3104967 3550031 3338154 227024046 114980372 117607495 112043674 43664145 66500525 0 0 0 0 334154 189003 17324557 20811865 244550154 254726229 19364508 17194315 0 0 0 0 81997346 80181268 0 0 0 0 79370 40482 0 0 6425915 8398838 107867139 105814903 X 136565788 148794099 117227 117227 0 0 136683015 148911326 244550154 254726229 X 5646696 5538834 0 0 0 1042781 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 1 0 0 0 0 1 0 0 1 4443 4443 0 Schedule C, Part II-B, Line 1 WISCONSIN HOSPITAL ASSOCIATION AND CATHOLIC HOSPITAL ASSOCIATION DUES ALLOCATED TO LOBBYING. 2654654 142898 408306 0 80000 0 3125858 2377224 24079 253351 0 0 0 2654654 2348831 0 28393 0 0 0 2377224 2061146 42722 244963 0 0 0 2348831 1704002 8085 349059 0 0 0 2061146 0.0936 0.6151 0.2913 0 1 1 0 1294964 1294964 0 140503552 53511846 86991706 0 0 0 0 0 79087873 58335183 20752690 0 6137657 3133343 3004314 112043674 RECEIVABLE FROM FOUNDATION 2008351 INVESTMENT IN UNCONSOLIDATED AFFILIATES 951704 INVESTMENT IN FOUNDATION 2776522 DEBT SERVICE RESERVE FUND 6293291 DEFERRED COMPENSATION 8781997 20811865 0 DEFERRED COMPENSATION 8398838 8398838 X 171881852 0 0 0 1247799 1247799 170634053 0 205019 205019 170839072 165192376 0 0 0 0 0 165192376 0 0 0 165192376 Schedule D, Part V, Line 4 THE OPERATING ENDOWMENT HAS BEEN ESTABLISHED TO SUPPORT THE OPERATING COSTS OF THE MONROE CLINIC AND HOSPITAL FOUNDATION. THE FUTURE OF HEALTHCARE ENDOWMENT HAS BEEN ESTABLISHED TO PROVIDE FUNDING FOR GRANTS AND PROGRAMS THAT SUPPORT THE MONROE CLINIC AND HOSPITAL FOUNDATION MISSION. Schedule D, Part X, Line 2 THE MONROE CLINIC IS A TAX EXEMPT CORPORATION AS DESCRIBED IN SECTION 501 C 3 OF THE INTERNAL REVENUE CODE (THE "CODE") AND IS EXEMPT FROM FEDERAL INCOME TAX ON RELATED INCOME PURSUANT TO SECTION 501 A OF THE CODE. THE CLINIC IS ALSO EXEMPT FROM STATE INCOME TAX. IN ORDER TO ACCOUNT FOR UNCERTAIN TAX POSITIONS THE CLINIC DETERMINES WHETHER IT IS MORE LIKELY THAN NOT THAT A TAX POSITION WILL BE SUSTAINED UPON EXAMINATION OF THE TECHNICAL MERITS OF THE POSITION, ASSUMING THE TAXING AUTHORITY HAS FULL KNOWLEDGE OF ALL INFORMATION. IF THE TAX POSITION IS NOT RECOGNIZED IN THE FINANCIAL STATEMENTS THE CLINIC RECORDED NO ASSETS OR LIABILITIES FOR UNCERTAIN TAX POSITIONS OR UNRECOGNIZED TAX BENEFITS IN 2013 OR 2012. FEDERAL TAX RETURNS FOR TAX YEARS 2008 AND BEYOND REMAIN SUBJECT TO EXAMINATION BY THE APPLICABLE FEDERAL AND STATE TAXING AUTHORITIES. Schedule D, Part XI, Line 2d INCREASE IN EQUITY IN UNCONSOLIDATED AFFILIATE 112,077, CHANGE IN INTEREST IN NET ASSETS OF THE FOUNDATION 1,135,722 TOTAL 1,247,799. Schedule D, Part XI, Line 4b OTHER 205,019 1 1 1 X 120 1 X 1 1 1 0 1 1 0 0 4592659 0 4592659 0.0278 0 0 16828458 0 16828458 0.1019 0 0 134038 0 134038 0.0008 0 0 21555155 0 21555155 0.1305 0 0 672795 0 672795 0.0041 0 0 152121 0 152121 0.0009 0 0 3050813 0 3050813 0.0185 0 0 0 0 0 0 0 0 142428 0 142428 0.0009 0 0 4018157 0 4018157 0.0244 0 0 25573312 0 25573312 0.1549 1 2257291 0 12803243 19602177 -6798934 X 1 1 1 1 MONROE CLINIC 515 22ND AVENUE MONROE WI 53566 X X X MONROE CLINIC 1 1 X X X X X X X X X X 12 1 0 1 X www.monroeclinic.org X X X X X X X X X 0 0 1 1 120 1 300 1 X X X X X X X X X 1 1 X X X X 1 0 X X X 1 X 0 0 Schedule H, Part V, Section B, Line 1 MONROE CLINIC'S COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) INCLUDED SOCIAL AND ECONOMIC FACTORS AS A CONTRIBUTOR TO THE HEALTH OF THE COUNTY'S RESIDENTS. BIRTH CHARACTERISTICS MORTALITY/LEADING CAUSES OF DEATH AND HEALTH BEHAVIORS WERE INCLUDED AS OTHER CONTRIBUTING FACTORS IN THE HEALTH NEEDS OF OUR COMMUNITIES. Schedule H, Part V, Section B, Line 3 MONROE CLINIC IS AN ACTIVE PARTICIPANT IN THE GREEN COUNTY HEALTHY COMMUNITIES COALITION. THE COALITION IS CO-CHAIRED BY REPRESENTATIVES FROM MONROE CLINIC, GREEN COUNTY HEALTH DEPARTMENT, AND THE UNIVERSITY OF WISCONSIN EXTENSION. THE GREEN COUNTY HEALTHY COMMUNITIES COALITION INCLUDES INDIVIDUALS WHO ARE EXPERTS IN PUBLIC HEALTH, LEADERS AND REPRESENTATIVES OF MEDICALLY UNDERSERVED, LOW-INCOME, MINORITY AND CHRONIC DISEASE POPULATION OR REGIONAL, STATE OR LOCAL HEALTH OR OTHER DEPARTMENTS OR AGENCIES THAT HAVE "CURRENT DATA OR OTHER INFORMATION RELEVANT TO THE HEALTH NEEDS OF THE COMMUNITY SERVED BY THE HOSPITAL FACILITY." A LIST OF THE COALITION MEMBERS WHO PARTICIPATED IN THE IDENTIFICATION OF PRIORITIZED HEALTH NEEDS, THEIR TITLES, ORGANIZATIONS AND LEADERSHIP ROLES CAN BE FOUND IN ATTACHMENT 2 OF THE CHNA. THE COALITION MET SIX TIMES BETWEEN MARCH 2011 AND SEPTEMBER 1, 2012, AVERAGING ATTENDANCE BY 40 COMMUNITY MEMBERS. Schedule H, Part V, Section B, Line 7 THE IMPLEMENTATION STRATEGY ADOPTED BY MONROE CLINIC ACTIVELY ADDRESSES THE HEALTH NEEDS THAT WERE IDENTIFIED IN THE CHNA AS "PRIORITY HEALTH NEEDS." CERTAIN OTHER HEALTH NEEDS THAT WERE IDENTIFIED BUT NOT SPECIFICALLY ADDRESSED IN THE IMPLEMENTATION STRATEGY INCLUDE: ALCOHOL AND OTHER DRUG USE, CHRONIC DISEASE PREVENTION AND MANAGEMENT, COMMUNICABLE DISEASE PREVENTION AND CONTROL, ENVIRONMENTAL AND OCCUPATIONAL HEALTH INJURY AND VIOLENCE, ORAL HEALTH, REPRODUCTIVE AND SEXUAL HEALTH, TOBACCO USE AND EXPOSURE. MONROE CLINIC HAS CHOSEN NOT TO FOCUS ON THESE AREAS BECAUSE WE BELIEVE WE CAN HAVE A GREATER IMPACT ON THE PRIORITY HEALTH NEEDS. TAKING EXISTING COMMUNITY RESOURCES INTO CONSIDERATION WE HAVE SELECTED TO CONCENTRATE ON THOSE HEALTH NEEDS THAT WE CAN MOST EFFECTIVELY ADDRESS GIVEN OUR AREAS OF FOCUS AND EXPERTISE THEREFORE THE HOSPITAL'S CHARITABLE RESOURCES WILL BE PLACED ON THE SELECTED PRIORITY HEALTH NEEDS. Schedule H, Part V, Section B, Line 12 MONROE CLINIC OFFERS ALL SELF-PAY PATIENTS A 10% DISCOUNT ON STANDARD RATES. IF THE PATIENT QUALIFIES FOR THE FINANCIAL ASSISTANCE POLICY, THE MINIMUM DISCOUNT PROVIDED IS 45%. Schedule H, Part V, Section B, Line 13 METHOD FOR APPLYING: PATIENTS MUST FIRST SEEK ASSISTANCE THROUGH OTHER RESOURCES. IF DENIED THEY MUST PROVIDE A LETTER OF DENIAL. IF AN APPLICATION IS MAILED TO A POTENTIAL APPLICANT IT MUST BE COMPLETED USING INCOME INFORMATION FOR THE LAST THREE MONTH PERIOD AND RETURNED TO THE PATIENT ACCOUNTS DEPARTMENT WITHIN 10 DAYS. IF THE POTENTIAL APPLICANT HAS BEEN A RECIPIENT OF COMMUNITY CARE IN THE RECENT PAST THEY DO NOT NEED TO RESUBMIT THE INCOME INFORMATION. Schedule H, Part V, Section B, Line 14 OTHER: 1. FINANCIAL COUNSELORS REACH OUT TO SELF-PAY INPATIENTS 2. CLINICAL DEPARTMENTS REFER PATIENTS TO FINANCIAL COUNSELORS 3. THE BILLING OFFICE WILL REFER PATIENTS WHEN ATTEMPTING TO COLLECT ON UNPAID BALANCES. Schedule H, Part V, Section B, Line 18 EFFORTS ARE MADE TO CONTACT ALL PATIENTS WITH OUTSTANDING BALANCES PRIOR TO REFERRING THEM TO A THIRD PARTY COLLECTOR. THESE ATTEMPTS INCLUDE PHONE CALLS, VOICEMAIL MESSAGES, AND LETTERS. PATIENTS ARE ALSO OFFERED NO INTEREST PAYMENT PLANS TO AVOID BEING REFERRED TO COLLECTIONS. PATIENTS EXPRESSING CONCERNS REGARDING PAYING THEIR BILLS ARE INFORMED OF THE COMMUNITY CARE PROGRAM. IF THE PATIENT DOES NOT QUALIFY FOR FINANCIAL ASISTANCE BUT HAS OTHER HARDSHIPS THAT ARE PREVENTING TIMELY PAYMENT OF THEIR BILL, EXTENDED PAYMENT TERMS MAY BE OFFERED AFTER THE COMPLETION OF A FINANCIAL DISCLOSURE. 10 MONROE CLINIC - HIGHLAND WOMEN'S CARE 3103 W KUNKLE BLVD FREEPORT IL 61032 COMMUNITY-BASED OUTPATIENT CLINIC MONROE CLINIC - FREEPORT 1301 S KIWANIS DRIVE FREEPORT IL 61032 COMMUNITY-BASED OUTPATIENT CLINIC MONROE CLINIC - FREEPORT EYE CARE 1110 S PARK BLVD FREEPORT IL 61032 COMMUNITY-BASED OUTPATIENT CLINIC MONROE CLINIC - BRODHEAD 1904 FIRST CENTER AVENUE BRODHEAD WI 53520 COMMUNITY-BASED OUTPATIENT CLINIC MONROE CLINIC - LENA 214 SCHUYLER LENA IL 61048 COMMUNITY-BASED OUTPATIENT CLINIC MONROE CLINIC - NEW GLARUS 1800 SECOND STREET NEW GLARUS WI 53574 COMMUNITY-BASED OUTPATIENT CLINIC MONROE CLINIC - ALBANY 700 CAROLAN DRIVE ALBANY WI 53502 COMMUNITY-BASED OUTPATIENT CLINIC MONROE CLINIC- DURAND 400 S CENTER STREET DURAND IL 61024 COMMUNITY-BASED OUTPATIENT CLINIC MONROE CLINIC FASTCARE 405 W 8TH ST MONROE WI 53566 COMMUNITY-BASED OUTPATIENT CLINIC MONROE CLINIC - BLANCHARDVILLE 309 S MAIN STREET BLANCHARDVILLE WI 53516 COMMUNITY-BASED OUTPATIENT CLINIC Schedule H, Part I, Line 3c IN ADDITION TO INCOME, THE MONROE CLINIC CONSIDERS ASSETS IN EXCESS OF $75,000 EXCLUDING THE APPLICANT'S PRIMARY RESIDENCE AND ESSENTIAL TRANSPORTATION. Schedule H, Part I, Line 7 A COST TO CHARGE RATIO WAS USED TO COMPUTE THE COST OF COMMUNITY BENEFIT SERVICES. Schedule H, Part I, Line 7g SUBSIDIZED HEALTH SERVICES INCLUDE BEHAVIORAL HEALTH/OUTPATIENT MENTAL HEALTH, PALLIATIVE CARE, RENAL DIALYSIS, SELF-HELP/SPORTS INJURY PREVENTION, CONTINUING CARE/HOME CARE SERVICES, AND EMERGENCY AND TRAUMA/EMERGENCY DEPARTMENT. Schedule H, Part III, Section A, Line 4 ACCOUNTS RECEIVABLE ARE UNCOLLATERALIZED PATIENT OBLIGATIONS THAT ARE STATED AT THE AMOUNT MANAGEMENT EXPECTS TO COLLECT FROM OUTSTANDING BALANCES. THESE BALANCES ARE PRIMARILY FROM RESIDENTS OF SOUTHERN WISCONSIN AND NORTHERN ILLINOIS. THE CLINIC BILLS THIRD PARTY PAYORS ON EACH PATIENT'S BEHALF OR IF A PATIENT IS UNINSURED THE PATIENT IS BILLED DIRECTLY. ONCE CLAIMS ARE SETTLED WITH THE PRIMARY PAYOR SECONDARY INSURANCE IS BILLED AND PATIENTS ARE BILLED FOR COPAY AND DEDUCTIBLE AMOUNTS FOR WHICH THE PATIENTS ARE PERSONALLY RESPONSIBLE. PAYMENTS ON ACCOUNTS RECEIVABLE ARE APPLIED TO THE SPECIFIC CLAIM IDENTIFIED ON THE REMITTANCE ADVICE OR STATEMENT. THE CLINIC DOES NOT HAVE A POLICY TO CHARGE INTEREST ON PAST DUE ACCOUNTS. THE CARRYING AMOUNTS OF ACCOUNTS RECEIVABLE ARE REDUCED BY ALLOWANCES THAT REFLECT MANAGEMENT'S BEST ESTIMATE OF THE AMOUNTS THAT WILL NOT BE COLLECTED. MANAGEMENT PROVIDES FOR CONTRACTUAL ADJUSTMENTS UNDER TERMS OF THIRD PARTY REIMBURSEMENT AGREEMENTS THROUGH A CHARGE TO GROSS REVENUE AND A CREDIT TO ACCOUNTS RECEIVABLE. IN ADDITION, MANAGEMENT PROVIDES FOR PROBABLY UNCOLLECTIBLE AMOUNTS PRIMARILY FROM UNINSURED PATIENTS AND AMOUNTS FOR WHICH PATIENTS ARE PERSONALLY RESPONSIBLE THROUGH A CHARGE TO OPERATIONS AND A CREDIT TO A VALUATION ALLOWANCE BASED ON ITS ASSESSMENT OF HISTORICAL COLLECTION LIKELIHOOD AND THE CURRENT STATUS OF INDIVIDUAL ACCOUNTS. BALANCES THAT ARE STILL OUTSTANDING AFTER MANAGEMENT HAS USED REASONABLE COLLECTION EFFORTS ARE WRITTEN OFF THROUGH A CHARGE TO THE VALUATION ALLOWANCE AND A CREDIT TO ACCOUNTS RECEIVABLE. ACCOUNTS RECEIVABLE ARE RECORDED IN THE ACCOMPANYING BALANCE SHEET'S NET OF CONTRACTUAL ADJUSTMENTS AND AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. Schedule H, Part III, Section B, Line 8 MEDICARE SHORTFALL IS NOT TREATED AS COMMUNITY BENEFIT. TO ARRIVE AT COST OF MEDICARE SERVICES THE TOTAL EXPENSES LESS OTHER OPERATING REVENUE IS MULTIPLIED BY THE RATIO OF MEDICARE REVENUE TO TOTAL REVENUE. Schedule H, Part III, Section C, Line 9b MONROE CLINIC RECOGNIZES THE INHERENT VALUE OF ALL INDIVIDUALS. ALL INDIVIDUALS HAVE THE RIGHT TO BE TREATED WITH RESPECT AND DIGNITY. THOSE INDIVIDUALS INDICATING LACK OF FINANCIAL RESOURCES TO PAY FOR SERVICES WILL BE DIRECTED TO MONROE CLINIC'S COMMUNITY CARE PROGRAM TO ENSURE ALL INDIVIDUALS QUALIFYING FOR ASSISTANCE ARE INDEED GIVEN ASSISTANCE. INDIVIDUALS WITH THE FINANCIAL RESOURCES TO PAY FOR SERVICES ARE EXPECTED TO DO SO IN A TIMELY MANNER TO ENSURE MONROE CLINIC'S FINANCIAL HEALTH AND ABILITY TO MAINTAIN OPERATIONS AND CONTINUED COMMUNITY CARE. PATIENTS WITH FINANCIAL RESOURCES ARE ASKED TO PAY CO-PAYMENTS AT THE TIME OF SERVICE AND TO PAY BALANCES REMAINING DUE AFTER INSURANCE HAS PAID WITHIN 30 DAYS OR MAKE MUTUALLY AGREEABLE PAYMENT ARRANGEMENTS WITH PATIENT ACCOUNTING. COLLECTION AGENCIES USED BY MONROE CLINIC GUARANTEE COMPLIANCE WITH THE FAIR DEBT COLLECTION PRACTICES ACT AND THE ACA INTERNATIONAL'S CODE OF ETHICS AND PROFESSIONAL RESPONSIBILITY. Schedule H, Part VI, Line 2 MONROE CLINIC IN COLLABORATION WITH THE GREEN COUNTY HEALTHY COMMUNITIES COALITION ASSESSED THE HEALTH CARE NEEDS OF THE COMMUNITIES IT SERVES USING THE STATE PUBLIC HEALTH AGENDA, HEALTHIEST WISCONSIN 2020, AS TEH FRAMEWORK. THE GOALS OF HEALTHIEST WISCONSIN 2020 ARE TO IMPROVE HEALTH ACROSS THE LIFE SPAN, AND ELIMINATE HEALTH DISPARITIES AND ACHIEVE HEALTH EQUALITY. THE HEALTH NEEDS WERE DERIVED FROM AN EXAMINATION OF DATA ON HEALTH BEHAVIORS AND THE SOCIAL, ECONOMIC AND EDUCATIONAL FACTORS THAT ARE DETERMINANTS OF HEALTH. Schedule H, Part VI, Line 3 MONROE CLINIC PROVIDES FINANCIAL COUNSELORS WHO ACT AS PATIENT ADVOCATES AND HELP THOSE IN NEED APPLY FOR MONROE CLINIC'S COMMUNITY CARE PROGRAMS OR OTHER STATE, COUNTY OR FEDERAL PROGRAMS. (ie. WISCONSIN BADGERCARE, WISCONSIN AND ILLINOIS WELL WOMAN PROGRAMS, MEDICARE, MEDICAID, ETC.) PATIENTS CAN FIND OUT ABOUT THESE SERVICES THROUGH MONROECLINIC.ORG'S INFORMATION PAGES, MONROE CLINIC'S ANNUAL MISSION REPORT POSTED ON OUR WEBSITE AND MAILED TO HOUSEHOLDS IN OUR SERVICE AREA, AND THROUGH COMMUNITY OUTREACH THAT OFFERS ASSISTANCE EXPLAINING NEW FEDERAL/STATE PROGRAMS OR CHANGES TO THOSE PROGRAMS. ADDITIONALLY, MONROE COUNSELORS HELP PATIENTS UNDERSTAND WHAT PROGRAMS THEY COULD BE ELIGIBLE FOR, HELP THEM THROUGH APPLICATION PROCEDURES AND ALSO PROVIDE APROVAL/DENIAL NOTIFICATION TO THE PATIENTS IN A TIMELY MANNER. Schedule H, Part VI, Line 4 MONROE CLINIC GIVES SPECIAL CONSIDERATION TO PERSONS IN NEED OF FINANCIAL ASSISTANCE THROUGH OUR COMMUNITY CARE PROGRAM. MONROE CLINIC DOES NOT DISCRIMINATE AGAINST A PATIENT BECAUSE OF RACE, CREED, COLOR, NATIONAL ORIGIN, OR BECAUSE A PATIENT IS COVERED BY A PROGRAM SUCH AS MEDICAID OR MEDICARE. FOR PATIENTS WHO HAVE NO HEALTH INSURANCE LIMITED HEALTH INSURANCE OR WHO EXPECT TO HAVE DIFFICULTY PAYING THEIR BILL THE COMMUNITY CARE PROGRAM PROVIDES HEALTHCARE AT A REDUCED COST OR AT NO COST. THE PROGRAM PROVIDES HEALTHCARE WITH A PAYMENT SCHEDULE THAT RECOGNIZES AN INDIVIDUAL'S FINANCIAL CONDITION. COMMUNITY CARE APPLICATIONS ARE ACCEPTED FROM PATIENTS WHO RESIDE IN OUR PRIMARY AND SECONDARY SERVICE AREAS WHICH INCLUDE THE FOLLOWING COUNTIES IN WISCONSIN: GREEN, LAFAYETTE, AND SECTIONS OF DANE, ROCK, AND IOWA COUNTIES. IN ILLINOIS: STEPHENSON AND SECTIONS OF WINNEBAGO AND JO DAVIES COUNTIES. INDIVIDUALS MUST BE A RESIDENT OF ONE OF THESE AREAS FOR A FOR A MINIMUM OF THREE MONTHS PRIOR TO BEING ELIGIBLE FOR THE COMMUNITY CARE PROGRAM. Schedule H, Part VI, Line 5 A MAJORITY OF THE MONROE CLINIC BOARD OF DIRECTORS IS COMPRISED OF PEOPLE THAT RESIDE IN THE GEOGRAPHIC AREAS WE SERVE. MONROE CLINIC RE-INVESTS BACK INTO THE COMMUNITY THROUGH ITS COMMUNITY BENEFIT PROGRAMS AND THROUGH MEDICAL EQUIPMENT AND PROGRAMS NEEDED IN THE COMMUNITY. EXAMPLES OF THIS INCLUDE PALLIATIVE CARE, PARISH NURSING PROGRAM, YOUTH APPRENTICESHIP AND JOB SHADOWING PROGRAMS, SCREENING OUTREACH AND MANY OTHER PROGRAMS. FURTHER, MONROE CLINIC HAS INVESTED IN THE ELECTRONIC HEALTH RECORD. OUR PATIENTS ARE GEOGRAPHICALLY DIVERSE AND MONROE CLINIC HAS TEN BRANCH PHYSICIAN CLINICS IN OUTLYING AREAS. THE INVESTMENT IN ELECTONIC HEALTH RECORDS MEANS THAT OUR PATIENTS CAN BE SEEN ANYWHERE AND HAVE THEIR MEDICAL HISTORY IMMEDIATELY AVAILABLE. THIS PROMOTES BETTER HEALTH FOR OUR PATIENTS AND INCREASED SAFETY AS WE CAN TRACK MEDICAL EVENTS AND ONGOING MEDICATION NEEDS. Schedule H, Part VI, Line 7 LIST OF STATES RECEIVING COMMUNITY BENEFITS REPORTS: WISCONSIN AND ILLINOIS X 1 1 X X X X 1 0 0 0 0 1 0 0 0 MICHAEL SANDERS PRESIDENT/CEO 447654 0 129821 0 3861 0 240287 0 21943 0 843566 0 129821 0 MARK THOMPSON CHIEF MEDICAL OFFICER 312635 0 63891 0 195 0 121724 0 23149 0 521594 0 63891 0 JOHN FREY PHYSICIAN/SECRETARY 238120 0 470 0 280 0 19823 0 26677 0 285370 0 470 0 RACHEL LONG PHYSICIAN/DIRECTOR 199923 0 282 0 150 0 16197 0 25418 0 241970 0 282 0 JULIE WILKE VP/CFO 246373 0 57143 0 449 0 96887 0 20475 0 421327 0 57143 0 PAULA RAIBLEY-ELMER VP/CHIEF NURSING OFFICER 183239 0 41948 0 1106 0 62429 0 20861 0 309583 0 41948 0 LANCE SATHOFF PHYSICIAN/ORTHOPEDIC SURGEON 1017578 0 470 0 98 0 40617 0 27394 0 1086157 0 470 0 NICHOLAS MAXWELL PHYSICIAN/GENERAL SURGEON 854991 0 470 0 280 0 35063 0 21412 0 912216 0 470 0 ANDREW RIKKERS PHYSICIAN/GENERAL SURGEON 846066 0 470 0 65 0 36080 0 27389 0 910070 0 470 0 LUCINDA WERKHEISER VP/SERVICE EXCELLENCE 135148 0 31530 0 254 0 44148 0 19315 0 230395 0 31530 0 DAVID BUCHANAN PHYSICIAN/INTERVENTIONAL CARDIOLOGIST 661692 0 217 0 429 0 19940 0 27394 0 709672 0 217 0 JONATHAN SWINDLE PHYSICIAN/ORTHOPEDIC SURGEON 599489 0 235 0 59 0 29059 0 27394 0 656236 0 235 0 JAMES NEMETH CHIEF FINANCIAL OFFICER 152900 0 12546 0 71 0 47589 0 18864 0 231970 0 12546 0 JANE WELDON FORMER VP/CLINICAL OPERATIONS 240427 0 0 0 1803 0 0 0 11041 0 253271 0 0 0 DARREN PIPP PHYSICIAN/DIRECTOR 325145 0 470 0 65 0 22207 0 21544 0 369431 0 470 0 CHRISTOPHER SMITH PHYSICIAN/CHIEF OF STAFF 238856 0 470 0 65 0 15943 0 24770 0 280104 0 470 0 Schedule J, Part I, Line 1a PROVIDED MEMBERSHIP FOR THE PRESIDENT/CEO TO THE LOCAL KIWANIS ORGANIZATION: TOTAL VALUE: 105 Schedule J, Part I, Line 3 THE ORGANIZATION'S CEO AND SENIOR LEADERSHIP TEAM'S COMPENSATION PLAN IS REVIEWED AND APPROVED AT FORMAL MEETINGS OF THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS. THE COMPENSATION COMMITTEE IS COMPRISED OF INDEPENDENT/NON-EMPLOYEE MEMBERS WHO HAVE NO PERSONAL INTEREST IN THE COMPENSATION ARRANGEMENT TO BE REVIEWED AND RECOMMENDED BY THE COMPENSATION COMMITTEE. THE COMMITTEE REVIEWS COMPARABLE WISCONSIN AND NATIONAL COMPENSATION DATA AND ESTABLISHES BASE COMPENSATION AT THE COMPARABLE MARKET MEDIAN BY POSITION AS OUTLINED IN THE COMPENSATION COMMITTEE CHARTER. ADDITIONALLY THE COMMITTEE HAS AUTHORITY TO RETAIN A COMPENSATION CONSULTANT TO ASSIST THE COMMITTEE IN EVALUATING SENIOR MANAGEMENT COMPENSATION. Schedule J, Part I, Line 4 JANE WELDON FORMER VP OF MINISTRY AND CLINICAL OPERATIONS WAS PAID A SEVERENCE OF 164,878 UPON HER DEPARTURE FROM THE ORGANIZATION. Schedule J, Part I, Line 6 THE ORGANIZATION USES NET EARNINGS AS 25% OF THE CALCULATION FOR THE GAIN SHARE PROGRAM. A REDEVELOPMENT AUTHORITY OF THE CITY 271322385 611420AP5 2009-11-24 64459717 CONSTRUCTION OF HOSPITAL 1 0 0 B WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITIES 391337855 2012-04-19 16415700 REFUNDING OF 1999 BOND ISSUE 0 0 0 C WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY 391337855 2012-04-19 21750843 PARTIAL ADVANCED REFUNDING OF 2009 ISSUE 0 0 0 A 0 20855000 64442747 4653664 6327046 0 1036820 0 0 57522008 0 0 2012 0 0 1 1 B 0 0 16415700 0 0 0 130700 0 0 0 16285000 0 2000 1 0 1 1 C 0 0 21750843 0 0 21459636 291207 0 0 0 0 0 2012 0 1 1 1 A 0 0 0 0 0 0 0 1 0 1 B 0 0 0 0 0 0 0 1 0 1 C 0 0 0 0 0 0 0 1 0 1 A 1 0 0 0 0 1 B 1 0 0 0 0 1 C 1 0 0 0 0 1 A 0 B 0 C 0 Schedule K, Part I, Column a REDEVELOPMENT AUTHORITY OF THE CITY OF MONROE. Schedule K, Part I, Column c WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITIES. Schedule K, Part II, Line 3 TOTAL PROCEEDS OF ISSUE VARIANCE BETWEEN ISSUE PRICE AND TOTAL PROCEEDS (16,970) IS THE LOSS ON THE INVESTMENT. SARAH ENDICOTT MICHAEL SANDER'S DAUGHTER 78819 EMPLOYMENT 1 LARA SALYER SMITH DO CHRISTOPHER SMITH'S SPOUSE 200456 EMPLOYMENT 1 Form 990, Part I, Line 1 SERVICES INCLUDE INPATIENT ROUTINE, INPATIENT ANCILLARY, AND OUTPATIENT HEALTHCARE IN SUPPORT OF THE CORPORATION'S HEALTH CARE MISSION. THE MONROE CLINIC, BECAUSE OF ITS MISSION STATEMENT, OFFERS A COMMUNITY PROGRAM TO ELIGIBLE BENEFICIARIES (THIS FALLS UNDER CHARITY CARE). Form 990, Part III, Line 4a DURING 2013 OUR PHYSICIANS AND STAFF PROVIDED SERVICES TO PATIENTS ACCESSING OUR SYSTEM IN TOTAL OVER 270,000 VISITS. IN 1939, CSA ESTABLISHED ST. CLARE HOSPITAL AT THE REQUEST OF A SMALL GROUP OF PHYSICIANS WHO OPENED MONROE CLINIC IN THE SAME YEAR. IN 1992 ST CLARE HOSPITAL AND MONROE CLINIC CONSOLIDATED UNDER CONTINUED SPONSORSHIP OF CSA AS A CATHOLIC NOT FOR PROFIT INTEGRATED HEALTHCARE FACILITY. MONROE CLINIC HAS A SPECIAL COMMITTMENT TO PROVIDE HEALTH CARE SERVICES TO ALL PATIENTS WITHOUT ANY FORM OF DISCRIMINATION INCLUDING THE ABILITY TO PAY. THE PASSION AND DETERMINATION OF BOTH THE FOUNDING PHYSICIANS AND CSA HAS DEVELOPED AN EXCEPTIONAL HEALTHCARE ORGANIZATION THAT FOCUSES ON QUALITY AND OUTCOME MEASURES THAT EXCEED NATIONAL BENCHMARKS. IN 2010 MONROE CLINIC COMMITTED TO PUBLISHING OUR QUALITY SCORES IN LOCAL NEWSPAPERS AND ON OUR WEBSITE. TO DATE WE HAVE BEEN AMONG THE HIGHEST PERFORMING HOSPITALS IN THE AREA. PATIENT SATISFACTION SCORES ARE SIGNIFICANTLY ABOVE THE AVERAGE OF OTHER HEALTHCARE FACILITIES. OUR HIGHLY TRAINED PHYSICIANS AND STAFF ARE READY TO PROVIDE BOTH EXCEPTIONAL HEALTH CARE AND AN EXCEPTIONAL EXPERIENCE TO THE PATIENTS AND COMMUNITIES WE SERVE. IN CALENDAR YEAR 2013 MONROE CLINIC PROVIDED MORE THAN $25.5 MILLION IN COMMUNITY BENEFIT TO MORE THAN 85,000 INDIVIDUALS. THIS $25.5 MILLION REPRESENTS APPROXIMATELY 15.9 PERCENT OF MONROE CLINIC'S TOTAL NET PATIENT REVENUE. THE COMMUNITY BENEFIT AT COST IS COMPRISED OF $4.6 MILLION OF CHARITY CARE, $16.8 MILLION IN UNREIMBURSED COSTS FOR MEDICAID PATIENTS, $3 MILLION IN SUBSIDIZED HEALTHCARE SERVICES (SERVICES PROVIDED TO PATIENTS AT LESS THAN WHAT IT COST US TO PROVIDE THESE SERVICES). EACH YEAR MONROE CLINIC USES SURPLUS FUNDS TO ENHANCE PATIENT AND SCREENING PROGRAMS. THROUGH OUR SPENDING AND THAT OF OUR EMPLOYEES MONROE CLINIC CONTRIBUTES SIGNIFICANTLY TO THE LOCAL COMMUNITY. Form 990, Part VI, Section A, Line 6 THE CORPORATION HAS TWO CLASSES OF MEMBERS. THE CLASS A MEMBERS ARE THE GENERAL SUPERIOR OF CSA AND THOSE PERSONS WHO ARE MEMBERS OF THE GENERAL COUNCIL OF CSA. THE CLASS B MEMBERS ARE INDIVIDUALS APPOINTED BY THE CLASS A MEMBERS AND CONSIST OF NOT LESS THAN NINE MEMBERS AND NOT MORE THAN 13 MEMBERS. Form 990, Part VI, Section A, Line 7a THERE IS A GOVERNING BODY THAT HAS FINAL APPROVAL FOR ANY NEW BOARD MEMBERS. Form 990, Part VI, Section A, Line 7b VARIOUS DECISIONS SUCH AS INDEBTEDNESS OF A CERTAIN SCOPE, MISSION OF THE ORGANIZATION, AND FINAL APPROVAL OF BOARD MEMBERS MUST BE BY CLASS A MEMBERS OF CONGREGATION OF SISTERS OF ST AGNES SONSORSHIP MINISTRY BOARD. Form 990, Part VI, Section B, Line 11b ANNUALLY, THE BOARD OF DIRECTORS IS PROVIDED AN OVERVIEW OF THE FORM 990 AND HAS AN OPPORTUNITY TO ASK QUESTIONS AND PROVIDE INPUT. Form 990, Part VI, Section B, Line 12c ANNUALLY, CONFLICT OF INTEREST STATEMENTS AND POLICY ARE DISTIBUTED TO MEMBERS OF THE BOARD AND ANY EMPLOYEE WHO HAS AUTHORITY TO ENTER INTO CONTRACTS AND OTHER TRANSACTIONS ON BEHALF OF MONROE CLINIC. THE COMPLETED FORMS ARE REVIEWED BY ADMINISTRATION. Form 990, Part VI, Section B, Line 15 THE ORGANIZATION'S CEO AND SENIOR LEADERSHIP TEAM'S COMPENSATION PLAN IS REVIEWED AND APPROVED AT FORMAL MEETINGS OF THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS. THE COMPENSATION COMMITTEE IS COMPRISED OF INDEPENDENT NON-EMPLOYEE MEMBERS WHO HAVE NO PERSONAL INTEREST IN THE COMPENSATION AGREEMENT TO BE REVIEWED AND RECOMMENDED BY THE COMPENSATION COMMITTEE. THE COMMITTEE REVIEWS COMPARABLE WISCONSIN AND NATIONAL COMPENSATION DATA AND ESTABLISHES BASE COMPENSATION AT THE COMPARABLE MARKET MEDIAN BY THE POSITION AS OUTLINED IN THE COMPENSATION COMMITTEE CHARTER. ADDITIONALLY THE COMMITTEE HAS AUTHORITY TO RETAIN A COMPENSATION CONSULTANT TO ASSIST THE COMMITTEE IN EVALUATING SENIOR MANAGEMENT COMPENSATION. Form 990, Part VI, Section C, Line 19 A PAPER COPY OF THE DOCUMENTS/STATEMENTS IS PROVIDED UPON REQUEST. Form 990, Part XI, Line 9 OTHER CHANGES IN NET ASSETS OR FUND BALANCES EQUITY IN EARNINGS OF UNCONSOLIDATED AFFILIATES 112,077, CHANGE IN INTEREST IN NET ASSETS OF FOUNDATION 1,135,723, OTHER (205,019), TOTAL 1,042,781. MONROE CLINIC AND HOSPITAL FOUNDATION INC 515 22ND AVENUE MONROE WI 53566 205769038 SUPPORT THE MISSION OF THE MONROE CLINIC WI 501(C) (3) LINE 7 N/A 0 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 WE FILED FOR AND WERE GRANTED THE AUTOMATIC 3 MONTH EXTENSION.